Protected bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia

Barreiro, Bienvenido; Dorca, Jordi; Manresa, F.; Català, Isabel; Esteban, Laura; Verdaguer, Ricard; Gudiol, Francesc

doi:10.1183/09031936.96.09071500

Cited by 25 publications

(11 citation statements)

References 27 publications

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“…A final result of 10 3 cfu/ml would indicate that the original material sampled in the airway contained a concentration of bacteria of 10 6 cfu/ml. Many studies have verified these findings and have found that bronchoalveolar lavage (BAL) provides similar information although with a cut-off value of 10 4 cfu/ml or more [26,27,28,29]. Studies that have failed to support the findings of Chastre et al [25] generally suffer from one or more critical faults, the most important of which is failure to account for antibiotic therapy appropriately.…”

Section: Diagnosis Of Nosocomial Pneumoniamentioning

confidence: 75%

Nosocomial pneumonia

Johanson

Dever

2002

Intensive Care Med

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Nosocomial pneumonia, or terminal pneumonia as it was formerly called, results from the repetitive microaspiration of contaminated oropharyngeal secretions into the lungs in the presence of impaired host defenses. This pathophysiologic sequence was suggested by the observations of Osler but clarified by the seminal work of Rouby and colleagues. The enormous impact of antimicrobial agents on the organisms responsible for nosocomial pneumonias was first identified by Kneeland and Price who found that organisms of the normal pharyngeal flora virtually disappeared in terminal pneumonias following administration of these drugs, being replaced by gram-negative bacilli. The remarkable susceptibility of seriously ill patients to becoming colonized by exogenous organisms, even in the absence of antimicrobial therapy, was shown by Johanson et al. These factors, antibiotics and the change in bacterial binding receptors in the airways associated with illness, lead to infections caused by exogenous organisms that are frequently resistant to antimicrobial agents. Clinical findings that usually identify patients with respiratory infections are unreliable for the diagnosis of nosocomial pneumonias as shown by Andrews et al. Invasive techniques, especially the protected specimen brush (PSB) technique, avoid contamination of the specimen by proximal secretions and accurately reflect the bacterial burden of the lung, as first shown by Chastre et al. Quantitation of such specimens serves as an excellent proxy for direct cultures of the lung and are the current gold standard for diagnosis.

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Section: Diagnosis Of Nosocomial Pneumoniamentioning

confidence: 75%

Nosocomial pneumonia

Johanson

Dever

2002

Intensive Care Med

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“…Note that there is a considerable overlap in clinical definitions in terms of fever, leukocytosis, purulent sputum, and change in oxygenation. 22 Some clinicians and investigators have relied on a combination of these factors that are included in the clinical pulmonary infection score (CPIS). [23][24][25][26] A score of at least 6 has been suggested as a marker of VAP.…”

Section: Diagnosis and Definitionsmentioning

confidence: 99%

Diagnosis of Ventilator-Associated Respiratory Infections (VARI): Microbiologic Clues for Tracheobronchitis (VAT) and Pneumonia (VAP)

Craven

Hudcova

2011

Clinics in Chest Medicine

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“…Bronchoalveolar lavage cultures have been advocated as a good technique to diagnose pneumonia in critically ill patients, with a sensitivity and specificity as high as 87% and 91%, respectively. [7][8][9] However, in a recent review, Ramzy et al 10 showed a lack of correlation of positive BAL culture results with abnormal radiographic chest examination results in burn patients.…”

Section: Commentmentioning

confidence: 99%

Sensitivity and Specificity of Bronchoalveolar Lavage and Protected Bronchial Brush in the Diagnosis of Pneumonia in Pediatric Burn Patients

Barret¹

1999

Arch Surg

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Background: Infection is still one of the leading causes of death in burn patients. The diagnosis of respiratory tract infection in critically ill burn patients is still difficult. The diagnostic technique of choice remains uncertain, especially because of the lack of a criterion standard by which other diagnostic methods can be compared. Hypothesis: Bronchoalveolar lavage (BAL) and protected bronchial brush (PBB) cultures are not efficacious for the diagnosis of pneumonia in critically ill burn patients. Design: All pediatric patients with burns who died at Shriners Burns Hospital, Galveston, Tex, in the past 10 years were studied. We compared the clinical diagnosis of pneumonia, BAL quantitative culture results, and PBB culture results with autopsy findings. The diagnosis of pneumonia at autopsy was considered the criterion standard, and it was used to calculate the sensitivity and specificity of BAL and PBB cultures. Results: Forty-three patients were studied. Pneumonia was present in 19 (44%) of the 43 autopsies. Pneumonia was diagnosed clinically in 12 (28%) of the 43 patients, and 6 (50%) of them had negative autopsy findings. The sensitivity and specificity of BAL were 56% and 28%, respectively; PBB, 55% and 61%, respectively. The same microorganisms were found at autopsy, in BAL cultures, and in PBB cultures in fewer than 10% of the patients. Conclusions: Bronchoalveolar lavage and protected bronchial brush have a low sensitivity and specificity and cannot be relied on by themselves for the diagnosis of pneumonia in critically ill burn patients. The results of these sampling techniques must be interpreted in the context of the overall clinical picture of each individual patient.

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Protected bronchoalveolar lavage in the diagnosis of ventilator-associated pneumonia

Cited by 25 publications

References 27 publications

Nosocomial pneumonia

Nosocomial pneumonia

Diagnosis of Ventilator-Associated Respiratory Infections (VARI): Microbiologic Clues for Tracheobronchitis (VAT) and Pneumonia (VAP)

Sensitivity and Specificity of Bronchoalveolar Lavage and Protected Bronchial Brush in the Diagnosis of Pneumonia in Pediatric Burn Patients

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